Bhutanese Refugees Are Killing Themselves At An Astonishing Rate

UNITED STATES, April 2013 (The Atlantic): Jai Subedi still doesn't know why Mitra Mishra killed himself. Subedi, a case manager for Bhutanese refugees at Interfaith Works Center for New Americans in Syracuse, NY, was with the 20-year-old Mishra at Schiller Park the evening of July 3, 2010. "We played soccer just the previous day until 6 p.m. and he was totally fine," Subedi said. On Independence Day, early morning walkers found Mishra's body hanging from a tree at the soccer field.

Mishra's death is part of a troubling pattern among Bhutanese refugees resettled in the U.S. The federal Office of Refugee Resettlement (ORR) began to notice a pattern. Ultimately, 16 suicides were confirmed among U.S. resident Bhutanese refugees as of February 2012. The International Organization for Migration (IOM) had noticed a similar trend among the Bhutanese in the camps in Nepal. IOM documented 67 suicides and 64 attempts between 2004 and 2010. The numbers were high, but without a statistical comparison, it was hard to know how bad the problem was.

ORR tasked the Center for Disease Control and Prevention and the Refugee Health Technical Assistance Center of the Massachusetts Public Health Department with investigating. By interviewing close contacts of the deceased (typically family members), the study team performed "psychological autopsies" on 14 of the 16 U.S. suicide victims. They also did a broader survey of the general Bhutanese refugee population to determine the rates of suicidal thinking and mental health conditions.

The study team confirmed the government's suspicions; the problem was endemic. The global suicide rate per 100,000 people--how suicide rates are calculated--is 16, and the rate for the general U.S. population is 12.4. The Bhutanese rate is much higher: 20.3 among U.S. resettled refugees and 20.7 among the refugee camp population. A handful of suicides were reported among other refugee groups during the same period as the CDC study, but nothing like the number among the Bhutanese.

The rate of depression among the Bhutanese surveyed was 21 percent, nearly three times that of the general U.S. population (6.7 percent). In addition to depression, risk factors for suicide included not being the family's provider, feelings of limited social support, and having family conflict after resettlement. Most of the suicides were within a year of resettlement to the U.S. and, in all cases, the victims hanged themselves.

Post-migration difficulties that the victims faced offer clues about their possible motivations. Most are unable to communicate with their host communities. Many were also plagued by worries about family back home and over the difficulty of maintaining cultural and religious traditions. Most of the victims were unemployed. While few had previous mental health diagnoses, mental health conditions were probably significantly under-diagnosed in the camps where medical care was basic at best.

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